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In Through the Nose

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It sounds like a magic trick—performing complex, dangerous brain surgery with no incisions and without touching cranial arteries and nerves. At Pitt, it’s no illusion.

In 1997, Pitt otolaryngologists Carl Snyderman and Ricardo Carrau began to navigate sinuses using endoscopes—devices, equipped with a light and a video camera, used for looking inside a body cavity or organ—to remove malformations from the base of the skull.

“We would stop at the bone that separates the sinuses from the brain,” Snyderman recalls. But more recently, drilling a thumbnail-sized hole through the bottom of the skull, behind the nose, has allowed Snyderman and his colleagues to remove previously inaccessible tumors.

Their work is part of the Endoscopic Neurosurgery/Skull Base Surgery Program at Pitt’s Minimally Invasive Cranial Base Center. At another of the center’s programs, the Cranial Nerve Disorders Program, neurosurgeons, including Michael Horowitz and Paul Gardner, use advanced diagnostic and monitoring techniques to treat patients for conditions like neuralgia (sharp pain in nerves) and vertigo.